A fast-track surgery programme leads to timelier treatment and higher resection rates in pancreatic cancer.

Abstract

The aim was to perform a propensity-matched comparison of patients with pancreatic cancer undergoing surgery, with and without biliary stenting and an intention to treat analysis of long-term survival between the two groups. This was an observational study of a cohort of consecutive patients presenting with obstructive jaundice and undergoing pancreatoduodenectomy for pancreatic and periampullary malignancies between November 2015 and May 2019. In this study of 216 consecutive operable patients, 70 followed the fast-track pathway and 146 had pre-operative biliary drainage. All 70 patients in the FT group and 122 out of 146 in the PBD group proceeded to surgery (100% and 83.6% respectively, p=0.001). Interval time from diagnostic CT scan to surgery and from MDT decision to treat to surgery was shorter in the FT group, (median 8 vs 43 days p<0.001 and 3 vs 36 days p<0.001 respectively) as was the overall time from diagnostic CT to adjuvant treatment (88 vs 121 days p<0.001). Postoperative outcomes including complications, readmission and mortality rates were comparable in the two groups. There was no difference in survival. For a person with pancreatic cancer who is proceeding to surgery, the best approach is to avoid pre-operative biliary drainage.